Outcomes in Patients With Peripheral Arterial Disease With and Without Prior Minor Amputation: A Comparative Analysis

Area of Science:

• Vascular Medicine
• Clinical Epidemiology
• Outcomes Research

Background:

• Peripheral arterial disease (PAD) poses a significant global health risk, particularly critical limb-threatening ischemia.
• The prognostic implications of a prior minor amputation (PMA) in PAD patients remain incompletely understood.
• This study investigates the association between PMA and outcomes in PAD patients.

Purpose of the Study:

• To compare major amputation and all-cause mortality rates in PAD patients with and without a history of PMA.
• To identify demographic and clinical factors associated with PMA in PAD patients.

Main Methods:

• Retrospective cohort study of 430 PAD patients at a tertiary vascular center.
• Patients stratified into PMA (n=72) and non-PMA (n=358) groups.
• Analysis included demographic data, comorbidities, treatments, major amputation rates, and all-cause mortality using Cox regression and Kaplan-Meier analysis.

Main Results:

• The PMA group exhibited higher rates of smoking and chronic kidney disease but lower utilization of antiplatelet and statin therapy.
• Multivariable analysis revealed that PMA was associated with a significantly lower adjusted risk of major amputation (HR 0.05) and all-cause mortality (HR 0.44).
• Statin therapy and anticoagulation were associated with reduced mortality, while revascularization was linked to increased mortality risk.

Conclusions:

• Prior minor amputation (PMA) is associated with lower adjusted risks of major amputation and mortality in PAD patients.
• These findings highlight the need for prospective validation of these observational associations.
• Prioritizing aggressive medical management is essential for all patients diagnosed with PAD.